Transcript Location of Phaloemulsification

Location of
Phacoemulsification
1234-
Ant Chamber
Iris Plane
Post chamber
Supracapsular
Anterior Chamber
1- Post capsule damage is minimized
2- Risk of corneal endothelium is more
3- Used if the posterior capsule has
ruptured or patient has high myopia
Iris Plane
1- Risk of damage to corneal
endothelium and post capsule is
reduced.
2- Good for small pupils.
3- Often desirable for beginners.
Posterior Chamber
1- Preferred location for phaco
2- More risk for post capsule
Supracapsular Phaco (1997)
Malony
1- More recent innovation
2- Reduces the stress on the zonules during
nucleus manipulation.
3- Can be used in small-pupil cases.
4- Needs a large capsulorrhexis.
5- Nucleus is flipped with hydrodisection.
Endolenticular
1- Uses a very small opening in ant capsule
2- Has maximum endothelial protection
3- Future possibility of injecting synthetic lens
material into an almost intact capsular bag
4- Increased risk of posterior capsule rupture
emulsification during both hydrodissection and
Whole-nucleus removal
The nucleus can be emulsified as a whole
1- In either the iris plane or the post
chamber
2- Needs large capsular opening
Chip and Flip Technique
1- Removal of the central core of the
nucleus by sculpting and creating a nuclear
bowl
2- Entire rim of inner nuclear bowl is removed and
the posterior nuclear chip remains
3- Soft epinuclear bowl acting as a cushion and it
should be tumbled or flipped and aspirated
Nucleus-splitting techniques
1- Hydrodelination separates hard
endonuclus
2- nucleus is divided into pieces before
removal from the capsular bag
Phacofracture technique
1- 4-quadrant nucleofracture technique
needs a deep central linear groove
2- Two perpendicular groove is made
Divide & Conquer
Divide & Conquer
Divide & Conquer
Divide & Conquer
Divide & Conquer
Chopping Techniques
described by Nagahara
horizontal chopping (Nagahara)
Vertical chopping (More recent)
Chopper
 Vertical chopper designs have a short, sharpened tip
that is able to penetrate the nucleus
HORIZONTAL PHACO CHOP
 In horizontal chop, the chopper tip must hook the
equator of the endonucleus peripherally beneath the
anterior capsule.
Phaco chop
Benefits of phaco chop are particularly
important for complicated cases such as
•
•
•
•
•
brunescent nuclei
white cataracts
loose zonules
capsulorhexis tears
small pupils
Stop and Chop, Koch and katzen
1- Modified this procedure with addition of a
central groove for better mobilizing
the nuclear fragments
Is a variation of divide and conquer
a- divide the nucleus to halves
b- chopping the remainng halves
Stop and chop
Vertical chop or quick chop
Needs a chopper specifically designed for
this technique
Nuclear Flip Technique:
Brown has desribed a variation on
earlier supracapsalar techniques
1- Needs a large capsulorrhexis
2- With hydrodisection the lens is flipped
into the ant chamber where it is
emulsified.